马陆社区家庭医生全专联合干预对糖尿病患者专病就诊行为与医保费用的影响

Influence of joint intervention of general department and specialist department of family doctor in Malu Community for special medical treatment behavior and medical insurance cost of diabetic

目的:探讨马陆社区全科-上海瑞金北院专科联合(以下简称"全专联合")干预对糖尿病患者专病就诊行为与医保费用的影响。方法:选取2012年1月-2015年12月纳入马陆镇社区卫生服务中心糖尿病健康管理的患者,其中参与家庭医生全专联合干预的4年分别为456名、517名、543名、535名,对照组为纳入家庭医生管理的非全专联合糖尿病患者,分别为1 237名、1 335名、1 526名、1 471名;比较两组临床资料。结果:2012-2015年,全专联合干预的糖尿病专病中位就诊次数和医保费用分别为8次、9次、11次、10次,435.02元、478.20元、537.60元、540.72元,非全专联合干预的糖尿病专病中位就诊次数和医保费用分别为7次、8次、8次、9次,258.70元、343.32元、362.88元、427.63元;高专病医保费用的糖尿病患者,其参与全专联合干预的比例,与低专病医保费用的糖尿病患者相比,2012-2014年差异有统计学意义(P<0.05),而2015年差异无统计学意义(P>0.05)。结论:采用全专联合干预可改善糖尿病患者的就医依从性,使糖尿病就医次数趋向合理化,对糖尿病专病医保费用结构的合理化有一定的推进作用。

Objective：To explore the influence of union of general department in Malu Community-specialist department in North Hospital of Ruijin of Shanghai（joint intervention of general department and specialist department） for special medical treatment behavior and medical insurance cost of diabetic.Methods：Patients who were included in the health management of diabetes from January 2012 to December 2015 in Malu Town Community Health Service Center were chosen,among them,the number of participation in joint intervention of general department and specialist department of family doctor was 456-517-543-535 respectively,the control group was diabetic patients managed by family doctor without joint intervention of general department and specialist department,the number was 1237-1335-1526-1471 respectively,we compared the clinical data of two groups.Results：From 2012 to 2015,the median number of medical visits and the cost of medical insurance of diabetic with joint intervention of general department and specialist department were 8-9-11-10 times and 435.02-478.20-537.60-540.72 Yuan respectively,the median number of medical visits and the cost of medical insurance of diabetic without joint intervention of general department and specialist department were 7-8-8-9 times and 258.70-343.32-362.88-427.63 Yuan respectively.The proportion in joint intervention of general department and specialist department of diabetic with high medical insurance costs was compared with diabetic with low medical insurance costs,the differences from 2012 to 2014 were statistically significant（P0.05）,in 2015,the difference was not statistically significant（P0.05）.Conclusion：The joint intervention of general department and specialist department can improve the compliance of diabetic patients,promote the rationalization of the frequency of medical treatment for diabetes,it had a certain propelling effect on the rationalization of the medical insurance cost structure of diabetic special disease.